Provider Demographics
NPI:1437143633
Name:OURS, CHAD DAVID (CPHT)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:DAVID
Last Name:OURS
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1709
Mailing Address - Country:US
Mailing Address - Phone:724-891-2047
Mailing Address - Fax:
Practice Address - Street 1:525 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:PA
Practice Address - Zip Code:15066-1737
Practice Address - Country:US
Practice Address - Phone:724-847-7979
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA290101040756430183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician